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Association Among SF36 Quality of Life Measures and Nutrition, Hospitalization, and Mortality in Hemodialysis

Kamyar Kalantar-Zadeh^*, Joel D. Kopple, Gladys Block and Michael H. Humphreys^*

* University of California, San Francisco and Division of Nephrology San Francisco General Hospital, San Francisco, California; University of California, Los Angeles, Division of Nephrology Harbor-UCLA Medical Center, Torrance, California; University of California, Berkeley, School of Public Health, Berkeley, California.

Correspondence to Dr. Kamyar Kalantar-Zadeh, Harbor-UCLA Medical Center, Division of Nephrology and Hypertension; and UCLA, 1000 West Carson Street, Harbor Mailbox 406, Torrance, CA 90509-2910. Phone: 310-222-3891; Fax: 310-782-1837; E-mail: kkalantar{at}rei.edu

ABSTRACT. Patients on maintenance hemodialysis (MHD) often show substantial reductions in quality of life (QoL). The SF36 (Short Form with 36 questions), a well-documented, self-administered QoL scoring system that includes eight independent scales and two main dimensions, has been widely used and validated. In 65 adult outpatients on MHD, the SF36 and its scales and dimensions, scored as a number between 0 and 100, and the nutritional and inflammatory state measured by subjective global assessment, near-infrared (NIR) body fat, body mass index (BMI), and pertinent laboratory values, including hemoglobin, albumin, and C-reactive protein were assessed. Twelve-month prospective hospitalization rates and mortality were used as the clinical outcomes. Multivariate (case-mix) adjusted correlation coefficients were statistically significant between SF36 scores and serum albumin and hemoglobin concentrations. There were significant inverse correlations between SF36 scores and the BMI and NIR body fat percentage. Hypoalbuminemic, anemic, and obese patients on MHD had a worse QoL. Prospective hospitalizations correlated significantly with the SF36 total score and its two main dimensions (r between -0.28 and -0.40). The Cox proportional regression relative risk of death for each 10 unit decrease in SF36 was 2.07 (95% CI, 1.08 to 3.98; P = 0.02). Of the eight components and two dimensions of the SF36, the Mental Health dimension and the SF36 total score had the strongest predictive value for mortality. Thus, in patients on MHD the SF36 appears to have significant associations with measures of nutritional status, anemia, and clinical outcomes, including prospective hospitalization and mortality. Even though obesity, unlike undernutrition, is not generally an indicator of poor outcome in MHD, the SF36 may detect obese patients on MHD at higher risk for morbidity and mortality.

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